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Monthly Archives: July 2013

After going through the posts I think for a while, what are the ethical /moral dilemmas I face as a Physio. Most of my thoughts ended up with dilemmas related to religious stuffs of the therapist / patient.

For example:

What will I do when am rushing for a prayer and my patient came for his/her treatment?

What will I do when my patient requested to adjust my busy schedule for his/her religious stuffs?

Does ethics vs morality issue arise only pertaining to religion? If there were no conflicts with respect to religion, everything is okay?????

I did a quick review on PUBMED to search about the documentation of these issues in Physiotherapy. I came across an excellent article (Guiccone,1980) which describes various situations where ethical dilemmas may arise.

Listing a few:

Establishing priorities for patient treatment when time or resources are limited.

Discontinuing treatment for patients who habitually disregard instructions such as for home programs, treatment regimens, and safety instructions.

Continuing treatment with a terminally ill patient.

Continuing treatment to provide psychological support after physical therapy treatment goals has been reached.

Determining professional responsibilities when a patient’ needs or goals conflict with the family’s needs or goals.

Defining the limits of the physical therapist’s role in the initial education of a patient/family regarding diagnosis or prognosis.

Deciding whether to represent certain necessary patient services in a way that would meet third party- payer limitations.

Medical educators and professional bodies increasingly recognize the importance of empathy, but they define empathy in a special way to be consistent with the overarching norm of detachment. Outside the field of medicine, empathy is an essentially affective mode of understanding. Empathy involves being moved by another’s experiences. In contrast, a leading group from the Society for General Internal Medicine defines empathy as “the act of correctly acknowledging the emotional state of another without experiencing that state oneself.” (Jodi Halpern, 2003)

The whole point of empathy is to focus attention on the patient.A listener who was busy having his or her own parallel emotions and introspecting about them would have the wrong focus.

For Example is a patient says that he / she has stopped doing his/her exercise empathy involves taking cues from his/her tone.Because he/she doesn’t feel unwell, or he/ she may see the exercise program as useless because of hopeless feel about getting well.

2) Patients trust physicians who respond to their anxiety with their own responsive worry. Trust has been associated with better treatment adherence.

3) It matters when and how physicians ask patients about their feelings, and empathic attunement guides physicians about when to ask questions, when to stay silent, and when to repeat important words.

Another example an be quoted from the case study of a GBS patient cited by Ann Hallum. The patient reported that she was terrified during the time she was totally paralysed (including eyelid movement) and on a respirator.

She said that nurse,doctors and hospital staff seemed to assume she could not hear because she was unable to respond in any manner.

In her word ” they acted like I was already dead”

Needless to say , Evidence is increasing that patients treated in acute trauma rooms or ICUs can have POST-TRAUMATIC STRESS SYNDROME.